HOW COMPELLING USER EXPERIENCE DESIGN CAN REDUCE THE HEALTH I.T. BURDEN
There’s been a lot of recent focus on the consumer when it comes to health information technology (health IT) It’s not unwarranted; we’ve been living in the “age of the customer” for a while now, and patients are continually expecting more from their healthcare experiences. But when it comes to the health IT infrastructure, the main component, electronic health record (EHR) systems — intended to bring higher-quality care and more empowerment to patients — has instead resulted in less quality time between doctor and patient, and even created patient safety risks tied to issues with the new technology.
The real issue at the core of all this and why EHR is falling short: user experience design. Stakeholders and developers need to shift their focus toward optimizing the current user experience and addressing usability issues; in other words, shifting the focus from creating “products” to “experiences.”
Where to start? With a better understanding of the end users of the technology and their needs.
THE NEGATIVE EFFECTS OF POOR EHR UX
While EHRs still offer the potential for countless benefits — with better interoperability between EHRs, we can gain unprecedented access to patient medical histories across healthcare providers, helping deliver more effective care — they’ve also introduced a whole new world of challenges for clinicians. These challenges are not only affecting clinical effectiveness for patients, they’re also greatly contributing to physician burnout; issues so significant that the Office of the National Coordinator for Health Information Technology put out a report in November last year to address them, “Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs.” The report came just weeks after The New Yorker published a telling piece containing both anecdotal and statistical evidence of these systemic flaws, “Why Doctors Hate Their Computers.” “The volume of knowledge and capability increases faster than any individual can manage — and faster than our technologies can make manageable for us,” Atul Gawande writes. “We ultimately need systems that make the right care simpler for both patients and professionals, not more complicated.”
Let’s Unpack How Healthcare I.T.’s UX Problems Affect Physicians
DOCUMENTATION REQUIREMENTS
EHRs use codes to represent different procedures, diagnoses and care plan-related information for billing purposes among others, which means doctors have to spend time translating their notes to numbers and entering them in the system. There are literally tens of thousands of diagnosis and procedure codes (over 110 for different types of diabetes, to put it in perspective), and numerous studies have found that clinicians are spending additional hours a day interacting with EHRs, sometimes spending more time in front of a monitor than in front of patients.
WORKFLOW IMPACT
Some of the excessive time spent entering codes is due to the fact that EHR systems aren’t designed to align with real-world clinical workflows. Since they’re typically accessed on a desktop computer in the examination room, physicians can’t enter information and tend to a patient at the same time; and if they do, that means having their back turned to the patient. EHRs were designed as an afterthought, and as a result don’t fit within the flow of the overall user experience, which leaves doctors spending less time with patients, and extra hours updating medical records at the end of their day.
EASE OF USE
In addition to the time and effort it takes to record information, the EHR interface design has created challenges. Patient information isn’t always well-organized and managed within these software systems, an information overload issue that has been exacerbated because often there is no way for the user to easily search and locate relevant information. The data is also displayed chronologically, making it difficult for clinicians to get the full picture of a patient’s health history.
HOW DESIGN CAN HELP
All of these problems come with user experience design implications; EHR systems and systems that integrate with EHRs have a tremendous need for better design and usability. By understanding the need for a contextual inquiry, and what technologies and modalities are most appropriate for clinicians to use, we can innovate new ways to improve the overall healthcare application experience. Consider the coding issue. Perhaps there’s a way to incorporate a voice interface. Physicians could dictate information to a device like an Amazon Echo that captures information; the physician just has to go through the records and confirm the data is correct after. Using iPads instead of computers on wheels or desktops could also present a solution to some of the EHR challenges — apps could integrate EHR data, and offer improved user interfaces that make it easier for physicians to find the information they’re looking for (plus the portability to have both patient and patient medical within their field of view).
4 Tips for Designing Better EHR UX
1. UNDERSTAND THE CONTEXT
You want to design user experiences that take into account the context of use, that way the user can easily incorporate the technology at the point where they are naturally documenting or consulting with a patient. This entails conducting ethnographic research, shadowing and observing users in a context in order to create user stories which then drive the right user experience design.
2. REFINE THE INFORMATION ARCHITECTURE
Go through the activity of mapping out the hierarchy and structure of the information presented through the system visually. This is critical for effective user experience design in complex systems. If everything is flat and on the same level, this will negatively impact usability. You don’t want to present too much information at once; bring the most important information to the surface level, then improve search and filtering tools so users can easily access the info they need.
3. OPTIMIZE INTERACTIONS WITH AUTOMATION
Focus on minimum viable information collection. Minimize the amount of redundant information collected from the user, and where appropriate, use existing records to fill in the details (e.g. if the system is requesting the patient’s age, and their DOB is already file, automatically populate this information).
4. USE THE APPROPRIATE MODALITY
Modality refers to the type of interface the user is interacting with and how data is transferred between the user and the system; this could be a touchscreen, a speech recognition mobile voice interface or even gesture-sensing modality. Depending on the situation, systems that take advantage of multiple modalities, and incorporate ways of communicating other than just via screens could be more effective for users.
The good news: Hospitals don’t have to overhaul their entire systems; incremental, supplementary changes can have big impacts on the overall user experience design. But the bigger point is that we should be approaching clinical devices from a user-centered perspective, with the same level of polish expected for a consumer product; a physician should have access to medical apps and systems that are as intuitive and enjoyable to use as, say, the Apple Watch (which now happens to be an FDA Class 2 medical device).
We hope to see more healthcare organizations partnering with technology companies to bring the design thinking necessary to implement best practices for experiences that both clinicians are accustomed to. If you can remove the user burden by focusing on the user experience design, you’ll have a more engaged clinician armed with the information they need, and ultimately, a patient with better outcomes.
